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Missing freed-up resources make a 'mockery' of PBC

More than half of practice-based commissioners will not receive the freed-up resources they are entitled to for 2008/9, according to a straw poll carried out by Practical Commissioning.

More than half of practice-based commissioners will not receive the freed-up resources they are entitled to for 2008/9, according to a straw poll carried out by Practical Commissioning.

Leading PBC thinkers said the finding chimed with what they were being told by practice-based commissioners on the ground and warned PBC would flounder if the issue was not addressed.

NAPC chair Dr Johnny Marshall said: ‘This trend in not honouring FUR agreements is extremely worrying. PCTs doing this are potentially positioning themselves as the rock on which clinical leadership and PBC will flounder. This cannot be allowed to happen as it will have disastrous consequences for an NHS facing increasing financial challenge.'

41228232Dr Stewart Findlay, PBC chair for Durham Dales cluster, said: ‘The figures don't surprise me and of course it demotivates GPs. Remember, this is not money GPs directly benefit from, it's money they want to reinvest in patient care.

‘It makes a mockery of PBC – what is the point of PBC if you can't make decisions that benefit your patients?'

The reason for the missing FURs is unclear. Less than a third (28%) of the 56 respondents – a mixture of mainly GPs and practice managers – cited their PCT's deficit as the reason for the FURs not being forthcoming, with 30% stating their PCT was not in deficit.

A further 42% gave the reason as ‘other' with individual responses including:

• criteria being tightened up

• disagreement over how money should be spent

• replacement of FUR with a local reward scheme

• total PBC budgets overspent.

Dr Donal Hynes, who has visited all the SHAs recently with the DH's PBC Improvement Team, said the FUR issue had been consistently raised. He said the problem was that commissioners were focusing on small changes, such as bringing down dermatology referrals, rather than connecting with the overall budget.

‘They might make some change but if they overspent in other areas then of course the PCT can't set a budget in deficit.'

He added: ‘The problem is by law the PCT can't set a deficit budget and hospital activity has to be met. So it's a case of having much more mature discussions between the practice-based commissioners and the PCT.'

He described the situation as ‘terribly demoralising' for both commissioners and PCTs.

‘The difference between fundholding and PBC is that the latter is about responsibility for the overall budget.'

At a speech to an NAPC regional meeting this month, Mark Britnell, director general of commissioning and system management at the Department of Health, repeated that PCTs would be held to account for delivery of PBC.

He said: ‘PBC is here to stay. It is part of the DH's new way of working where clinical engagement is at the heart of the changes to healthcare we aspire to deliver in partnership.'

Dr Johnny Marshall: not honouring FUR deals is unacceptable Dr Johnny Marshall: not honouring FUR deals is unacceptable Survey results

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